Bradley Summers-Johnson

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY60981886 Issued in WA

Practice address

2817 Rock Merritt Ave
Fort Liberty, NC 28310-2697

Phone

(910) 907-8922

Fax

(910) 907-6069

NPI assigned

Jan 13, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1154787687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11022 DEAN CT SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984983732",
            "telephone_number": "503-801-9259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE",
            "city": "FORT LIBERTY",
            "state": "NC",
            "postal_code": "283102697",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERS-JOHNSON",
        "first_name": "BRADLEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-13",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY60981886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alice Margaret Stewart, MA, ATR-BC
• James D Stillwell, PA-C
• George William Stone, M.D.
• Jeffrey Dean Strong, LCSW, LCAS, CCS
• Lauren Von Almen Sturm, PA-C
• Lisa Currrence Tapscott, M.A. CCC-SLP
• Sameh Dawoud Tawadrous, DDS
• Anthony John Tesora, PTA
• Laura Marie Thompson
• Tom Patrick Timothy, PA

• Psychologist in Fort Liberty, NC
• Providers in Fort Liberty, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.